Impact of Preexisting Metabolic Risk Factors on the Choice of Antipsychotics

A study in this month’s Psychiatric Services examined the association between patients’ preexisting metabolic risk factors and the physician’s choice of antipsychotic agent based on its propensity to cause metabolic side effects.

Over a span of 3 years, 1,898 office-based visits were identified during which prescriptions of antipsychotics were mentioned. Antipsychotics were classified as having high, medium, or low risk based on their propensity to cause metabolic abnormalities; a separate category for antipsychotic polypharmacy was specified for visits during which multiple antipsychotics were mentioned. Patients’ preexisting metabolic risk was assessed by the presence of diabetes, hyperlipidemia, obesity, or hypertension.

Results showed that compared with patients of normal weight or who were underweight according to body mass index, obese patients were less likely to receive antipsychotics with high risk (relative risk ratio [RRR]=.14, 95% confidence interval [CI]=.05–.37) or medium risk (RRR=.39, CI=.19–.78) of causing metabolic abnormalities. However, having preexisting metabolic conditions, such as diabetes, hyperlipidemia, or hypertension, had little effect on physicians’ choice of antipsychotics with regard to metabolic risk properties.

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